If you have been told you have calcific tendonitis, or you have sudden shoulder pain that feels far more intense than expected, it is natural to wonder whether it will settle by itself or whether you need treatment. At RAD Clinics, we often see patients who are worried because the pain has affected sleep, work, dressing, driving or exercise.
Calcific tendonitis happens when calcium deposits form inside a tendon. It most commonly affects the shoulder, especially the rotator cuff tendons, but it can also occur around the hip, knee, Achilles tendon or elbow. Some calcium deposits cause no symptoms at all. Others can become extremely painful, particularly when the body starts to break down the deposit.
The reassuring news is that calcific tendonitis can go away on its own in some people. The less reassuring part is that this process can be unpredictable and may take months, or sometimes longer. When pain is severe, sleep is disturbed, or movement becomes limited, assessment and treatment may help you recover more comfortably and avoid ongoing disruption.
Who is this guide for?
This guide is for adults in the UK who have been diagnosed with calcific tendonitis, or who have shoulder or tendon pain and want to understand whether calcium deposits may be involved.
It is also helpful if you are considering private assessment or treatment and want to know what options are available, including ultrasound-guided injections or calcific barbotage. At RAD Clinics, we accept self-referrals, so you do not need a GP letter to book an assessment.
What is calcific tendonitis?
Calcific tendonitis is a condition where small calcium deposits build up inside a tendon. A tendon is the strong band of tissue that connects muscle to bone.
The exact cause is not fully understood. It is thought to involve a change in the normal tendon repair process, where calcium crystals form and collect within the tendon tissue. Calcific tendonitis is most often seen in adults between the ages of 30 and 60, and it appears to be more common in women.
Many people hear the word calcium and worry that it means arthritis, bone disease or something serious. In most cases, calcific tendonitis is a local tendon problem rather than a dangerous condition. It is not cancer, and it is not the same as general wear-and-tear arthritis.
Where does calcific tendonitis most commonly occur?
Calcific tendonitis most commonly affects the shoulder, particularly a rotator cuff tendon called the supraspinatus. The rotator cuff is a group of muscles and tendons that help lift and rotate your arm.
Although the shoulder is the most common and clinically important site, calcium deposits can also affect:
- The hip, especially the gluteal tendons near the outside of the hip
- The knee, including the patellar tendon
- The Achilles tendon
- The elbow tendons
When people search for calcific tendonitis of the shoulder, they are usually referring to calcium deposits within the rotator cuff. This can cause pain when lifting the arm, reaching overhead, reaching behind the back, putting on clothes or lying on the affected side.
Why is calcific tendonitis so painful?
One of the most common questions we hear is: Why is calcific tendonitis so painful?
The answer is usually linked to the stage of the condition. Calcific tendonitis can be quiet for a long time, then suddenly flare. During the acute resorptive phase, the body starts trying to break down the calcium deposit. This can trigger a strong inflammatory reaction around the tendon.
Inflammation can also affect the subacromial bursa, a small fluid-filled cushion in the shoulder. When the bursa becomes irritated, shoulder movement can become sharply painful.
This is why calcific tendonitis can sometimes feel out of proportion to what caused it. You may not remember a clear injury, but the pain can still be severe enough to disturb sleep or make simple movements difficult.
What are the stages of calcific tendonitis?
Calcific tendonitis usually moves through stages, although not everyone follows a neat pattern. Understanding these stages helps explain why the condition can sometimes feel quiet for a long time, then suddenly become extremely painful.
| Stage | What is happening? | Typical symptoms |
|---|---|---|
| Pre-calcific stage | The tendon tissue starts to change before calcium forms. | Often mild symptoms or no symptoms. |
| Formative stage | Calcium crystals are deposited within the tendon. | Pain can vary. Some people have discomfort, while others have no symptoms, and the deposit is found on imaging. |
| Resorptive stage | The body starts trying to break down and absorb the calcium deposit. This causes inflammation. | Usually, the most painful stage. Pain may be sudden, severe and worse with movement or lying on the shoulder. |
| Post-calcific stage | The calcium deposit has reduced or resolved, and the tendon begins to remodel and heal. | Pain usually settles, although some stiffness or weakness may remain for a short period. |
This is why calcific tendonitis can feel unpredictable: the same calcium deposit may be quiet for a long time, then become suddenly painful when the body starts to break it down.
Can calcific tendonitis go away on its own?
Yes, calcific tendonitis can go away on its own. In many cases, the body can gradually break down and reabsorb the calcium deposit.
However, the timing is unpredictable. Some painful episodes improve within weeks, while the full natural process can take months or even years. Not every deposit fully disappears. Some remain visible on imaging and may cause repeated flare-ups or ongoing pain.
At RAD Clinics, we usually consider treatment when pain is severe, sleep is badly affected, shoulder movement is limited, symptoms keep returning, or the condition has not improved with sensible conservative care.
How is calcific tendonitis diagnosed?
Calcific tendonitis is diagnosed through a clinical assessment and imaging.
An X-ray can show calcium within the tendon. Ultrasound gives more detail because it allows us to assess the size, position and consistency of the deposit. It can also show whether there is bursitis, tendon irritation or other soft tissue changes.
At RAD Clinics, MSK ultrasound is central to how we assess calcific tendonitis. It helps us confirm the diagnosis and decide whether the deposit may be suitable for ultrasound-guided treatment, such as corticosteroid injection or barbotage.
MRI is not always needed, but it may be useful if there is concern about other shoulder problems, such as a rotator cuff tear or more complex joint pathology.
Can ultrasound detect calcific tendonitis?
Yes. Ultrasound is very useful for detecting and characterising calcific tendonitis.
It can show whether the deposit looks hard and shadowing, or softer and more fluid-like. This matters because softer deposits are often more suitable for barbotage, while harder deposits may be more difficult to wash out.
Ultrasound also allows dynamic assessment, meaning the clinician can examine the tendon while the shoulder moves. Doppler ultrasound can help identify inflammation around the tendon or bursa.
What are the calcific tendonitis treatment options?
Treatment depends on how painful the condition is, how long it has been present, and what the calcium deposit looks like on imaging.
For mild symptoms, conservative care may be enough. This can include rest from aggravating activities, sensible activity modification, pain relief such as paracetamol or anti-inflammatory medication if suitable for you, and physiotherapy.
Physiotherapy can help maintain shoulder movement, reduce stiffness and rebuild strength around the rotator cuff and shoulder blade muscles.
If inflammation is a major driver of pain, an ultrasound-guided corticosteroid injection may be considered. This does not remove the calcium deposit, but it can reduce bursitis and provide meaningful pain relief for some patients.
Another option is calcific tendonitis removal through ultrasound-guided barbotage, also known as lavage or washout. During this procedure, the clinician uses ultrasound to guide a needle into the calcium deposit. Local anaesthetic is used, and sterile saline is used to help break up and wash out the calcium material.
Extracorporeal shockwave therapy, or ESWT, is another specialist option. Surgery is usually reserved for persistent cases that do not respond to non-surgical treatment.
Is ultrasound-guided barbotage available at RAD Clinics?
Yes. At RAD Clinics, we offer ultrasound-guided procedures for calcific tendonitis as part of our MSK injection and intervention service.
Before any procedure, we assess your symptoms and perform an ultrasound scan. This helps us understand whether the deposit is suitable for barbotage, whether a corticosteroid injection may be more appropriate, or whether another route would be safer and more effective.
We will always explain what we find and discuss your options clearly, so you understand the reasoning behind any recommendation.
What other injection options are available?
Where appropriate, we may discuss ultrasound-guided corticosteroid injection to calm inflammation in the bursa and surrounding tissues. This can be helpful when pain is driven by bursitis, especially if sleep and movement are badly affected.
In selected tendon cases, platelet-rich plasma, known as PRP, may also be discussed where tendon repair support is part of the wider treatment plan. PRP is not a simple calcium removal treatment, so suitability depends on the scan findings and clinical picture.
All injections at RAD Clinics are ultrasound-guided, which means we use real-time imaging to guide placement accurately.
How long does calcific tendonitis last?
The duration varies widely. An acute painful flare may settle over days to weeks, especially once inflammation reduces. However, the overall course of calcific tendonitis can last much longer. Some deposits resolve over months. Others persist for years or cause repeated flare-ups. This is why imaging is helpful. It allows us to see the deposit rather than guessing from symptoms alone.
How to sleep with calcific tendonitis
Sleep can be one of the hardest parts of calcific tendonitis, especially when the shoulder is in an acute, painful phase.
Try not to lie directly on the affected shoulder. Many people feel more comfortable lying on the opposite side with a pillow supporting the painful arm. This keeps the shoulder in a more neutral position and reduces pulling through the tendon.
Sleeping on your back with a pillow under the affected arm may also help. Some people find a slightly propped-up position more comfortable during a flare.
Pain relief before bed may help in the short term, but please check with your own doctor or pharmacist, especially if you have stomach, kidney, heart, blood pressure or medication-related concerns.
Do you need a GP referral for calcific tendonitis treatment?
No. You do not need a GP referral to book with RAD Clinics. We accept self-referrals for adults with suspected or confirmed calcific tendonitis. You can book directly through our website or by calling the clinic. Call us if you would like to discuss whether RAD Clinics is the right first step before booking. We see patients across our clinics in Northampton, Milton Keynes and St Neots. If fees are mentioned on our website, booking page or during enquiry, please note that prices are subject to change. We always recommend checking the latest fee information directly with RAD Clinics at the time of booking.
What happens during a calcific tendonitis appointment at RAD Clinics?
Your appointment starts with a careful discussion about your symptoms, including when the pain began, how severe it is, what movements trigger it, and whether it affects sleep or daily activity.
We then perform an ultrasound scan of the affected tendon. This allows us to identify the calcium deposit, assess its size and consistency, check for bursitis, and look at the surrounding soft tissues.
After the scan, we explain the findings in plain language. If treatment is suitable, we discuss the options, which may include an ultrasound-guided corticosteroid injection or barbotage. In some cases, treatment may be carried out during the same appointment if clinically appropriate.
You will also receive aftercare advice, including what to expect afterwards, how to manage short-term soreness, when to return to activity, and whether physiotherapy or follow-up imaging may be helpful.
Key takeaways
- Calcific tendonitis is caused by calcium deposits forming inside a tendon, most commonly in the shoulder rotator cuff.
- It can go away on its own, but the timing is unpredictable, and symptoms can be very painful during the inflammatory phase.
- Ultrasound is useful because it confirms the diagnosis, shows the type of deposit and helps guide treatment decisions.
- Treatment options include physiotherapy, corticosteroid injection, shockwave therapy and ultrasound-guided barbotage.
- At RAD Clinics, we offer assessment and ultrasound-guided treatment for calcific tendonitis in Northampton, Milton Keynes and St Neots.
- Self-referrals are welcome, and no GP referral is required.
Conclusion
Calcific tendonitis can sometimes settle naturally, but it is not always worth simply waiting and hoping, especially if pain is severe, sleep is disrupted, or shoulder movement is becoming limited. With the right assessment, you can understand whether the deposit is likely to settle on its own or whether treatment may help.
At RAD Clinics, we use MSK ultrasound to diagnose calcific tendonitis clearly and guide treatment where appropriate. Whether you need reassurance, an injection to calm inflammation, or ultrasound-guided barbotage to treat the deposit, we will talk you through your options in a calm, practical and patient-focused way.
Common questions about calcific tendonitis
How to sleep with calcific tendonitis?
Sleep on your back or unaffected side with a pillow supporting the affected arm or shoulder. This position reduces pressure on the tender tendon and minimises nighttime pain.
What causes calcification of tendons?
Repetitive micro-trauma and reduced oxygen supply to the tendon trigger calcium deposit formation. The body’s own repair process mistakenly lays down calcium crystals within the tendon fibres.
How long does calcific tendonitis last?
Calcific tendonitis typically lasts between 3 to 6 months, though some cases resolve within weeks or persist over a year. The condition moves through pre-calcific, calcific, and resorptive stages, each with different symptom durations.
Can calcific tendonitis come back?
Yes, calcific tendonitis recurs in approximately 10–15% of patients after successful non-surgical treatment. Recurrence usually happens in the same tendon or the opposite shoulder.
References
- NICE. Extracorporeal shockwave therapy for calcific tendinopathy in the shoulder. Published November 2022.
- Whittington Health NHS. Calcific tendinopathy patient information. Updated May 2025.
- Doncaster and Bassetlaw Teaching Hospitals NHS. Shoulder Calcific Tendonitis patient information.
- Werry WD et al. Determining the efficacy of barbotage for pain relief in calcific tendinitis. 2024.
